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PubMed1995

Reconstruction and augmentation patients' reaction to the media coverage of silicone gel-filled implants: anxiety evaluated.

Media coverage tends to focus on sensational aspects. Especially prominent are controversial items related to public health and well-being. This research examined the response by breast-reconstruction and breast-augmentation patients to extensive media coverage regarding silicone gel-filled implants. Results of our survey suggested that media coverage influenced these women. Common concerns expressed by respondents included autoimmune disease, capsular contracture, leakage, increased risk of cancer, and anxiety. All respondents used consultation with their physicians as a primary means of coping with anxiety. Anxiety over media coverage led to some hesitancy concerning use of implants by surveyed patients. Patients who experienced difficulty with their reconstruction noted more anxiety associated with media coverage.

Adaptation, Psychological↗

PubMed2004

The use of high-selenium yeast to raise selenium status: how does it measure up?

Selenium-enriched yeast (Se-yeast) is a common form of Se used to supplement the dietary intake of this important trace mineral. However, its availability within the European Union is under threat, owing to concerns expressed by the European Community (EC) Scientific Committee on Food that Se-yeast supplements are poorly characterised and could potentially cause the build up of Se in tissues to toxic levels. The present review examines the validity of these concerns. Diagrams of the biosynthesis and metabolism of Se compounds show which species can be expected to occur in Se-yeast preparations. Se-yeast manufacture is described together with quality-control measures applied by reputable manufacturers. The way in which speciation of Se-yeast is achieved is explained and results on amounts of Se species in various commercial products are tabulated. In all cases described, selenomethionine is the largest single species, accounting for 54-74 % of total Se. Se-yeast is capable of increasing the activity of the selenoenzymes and its bioavailability has been found to be higher than that of inorganic Se sources in all but one study. Intervention studies with Se-yeast have shown the benefit of this form in cancer prevention, on the immune response and on HIV infection. Of about one dozen supplementation studies, none has shown evidence of toxicity even up to an intake level of 800 microg Se/d over a period of years. It is concluded that Se-yeast from reputable manufacturers is adequately characterised, of reproducible quality, and that there is no evidence of toxicity even at levels far above the EC tolerable upper intake level of 300 microg/d.

Biological Availability↗

PubMed1991

[Risk factors for coronary heart disease].

Cardiovascular disease remains the major cause of death in the industrialized world with dyslipidemia, hypertension and cigarette smoking leading a long list of risk factors. Recently, controversy arose from some critical articles expressing concern about the evaluation and interpretation of statistical data of epidemiologic studies. One study using covariance analysis reported an absence of the widely accepted negative association between coronary heart disease (CHD) and high density lipoprotein (HDL) cholesterol. Also criticism was expressed regarding the cost-effectiveness of preventive measures such as the use of lipid lowering drugs on life expectancy. Because of such recent scientific controversy and discussions already taking place in the media, we have summarized in this article recent epidemiologic evidence including a meta-analysis of the major epidemiologic studies on HDL. We have directed particular attention to 3 large epidemiological studies, i.e., the Familial Atherosclerosis Treatment Study (FATS), the Program on the Surgical Control of the Hyperlipidemias (POSCH), and the Cholesterol Lowering Atherosclerosis Study (CLAS), all of which have clearly demonstrated a desirable effect of intensive lipid lowering therapy on coronary lesions.

Austria↗

PubMed1996

Increase of HLA-DR-positive natural killer cells in peripheral blood from patients with IgA nephropathy.

Previous in vivo and in vitro studies have presented various abnormalities of cellular immunity in patients with IgA nephropathy (IgAN). In the present study, we described increased expression of HLA-DR antigens on peripheral natural killer cells (NK cells) in relation to altered cytokine interactions. The numbers of HLA-DR expressing NK cells were enumerated by two-color flow cytometry and found to be significantly increased in patients with IgAN. Peripheral blood mononuclear cells were then fractionated into pure NK cells by a magnetic cell-sorting system and analyzed concerning expression of messages of interleukin (IL)-2, IL-4, tumor necrosis factor (TNF)-alpha, and interferon (IFN)-gamma by semiquantitative reverse transcriptase polymerase chain reaction (RT-PCR). Among the four cytokines, only the IFN-gamma message was significantly increased in patients' NK cells. Furthermore, intensity of the IFN-gamma message in NK cells showed positive correlation with the percentage of HLA-DR-positive NK cells from the same patient. Then we assayed serum levels of IL-2, IL-12, and IFN-gamma by enzyme-linked immunosorbent assay (ELISA) and the levels of IL-12 and IFN-gamma showed positive correlations with HLA-DR expression on NK cells. Creatinine clearance of the patients was reevaluated 36 months later, and patients with high HLA-DR on NK cells tended to show faster deterioration of renal function than patients with lower HLA-Dr expression. On the basis of these findings, we suggested that HLA-DR-positive NK cells in patients with IgAN form an "activated" population that produces IFN-gamma, and this unique cell population may be maintained by multiple factors and be involved in the development and progression of IgAN.

Adult↗

PubMed2002

Attitudes to absenteeism among diploma nursing students in Ireland - an exploratory descriptive survey.

Nurse education within Ireland is currently in a transition period. October 2002 heralds the national implementation of a third-level four-year degree based programme for the preparation of nurses, to replace the current three-year diploma system. Anecdotally, one concern expressed by nurse educators regarding this move, is the regulation and monitoring of student non-attendance. This study explores the views of those involved in nurse education in Ireland to absenteeism among diploma nursing students to ascertain whether or not concern exists. The findings reveal absenteeism as a potential problem among nursing students. Most respondents agree that student attendance at both the practical and theoretical aspect of current education programmes is a problem. There is overwhelming agreement that student attendances while on the clinical area should be monitored, while the majority of respondents agree that attendance monitoring during lectures should take place. Some divergent views emerge among the lecturers and tutors with the lecturers seeming more 'liberal' on average than the tutors, reflecting perhaps the different traditions of their environments. Mostly however, the differences between the two groups are small and statistically insignificant. Overall responses indicate a continued commitment to monitoring and control of absenteeism in this population. Systematic policies need to be developed and enforced and key personnel need to be employed to support attendance monitoring in the third level setting.

Absenteeism↗

PubMed1997

Parental concerns of Mexican American first-time mothers and fathers.

The purpose of the study was to identify the parental concerns of Mexican American first-time mothers and fathers using an ethnographic approach. The study was conducted for 10 months in Hidalgo County, Texas. Twenty-six families were followed longitudinally during their first 6 months of parenting with an average of eight (SD = 1.8) home visits per family. Audio-taped conversations with participants were transcribed verbatim in their entirety in either Spanish or English. Spanish transcripts were translated and checked for accuracy by a local consultant. Salient parental concerns derived from content analysis were infant illness, providing for the material needs of the infant, threats infants face in the future, knowing how to rear an infant, and facing job loss. Public health nurses can collaborate with parents by working from expressed concerns to enhance family health and the health of the local community.

Adult↗

PubMedDate not supplied

Cancer prevention in the community: a survey of community residents.

Lifestyle exposures account for the greatest proportion of risk factors for cancer, yet these exposures have proven most difficult to alter. Despite intensive intervention efforts, many behaviour change programs are ill suited to the community. This research was undertaken to increase our understanding of prevention activities of interest to a sample of residents in two Ontario communities. 248 (62.3%) adult residents responded to a semi-structured self-administered questionnaire including open-ended questions on health issues, exposures and prevention activities of interest. While some of the beliefs expressed by respondents might have been anticipated (e.g., cigarette smoking and family history increase risk of cancer), others were not (e.g., only between 40 and 75% of respondents thought a high fat diet increased risk). Furthermore, many of those with personal health concerns expressed an interest in prevention. This process is proposed as a first step in launching more appropriate and sustainable community-based health promotion programs for cancer prevention.

Adult↗

PubMed1987

Patient preparation in pediatric surgery.

This article has outlined the developmental concerns which make pediatric preparation for surgery a necessity. The goals, methodology, and essential elements of programming have been presented, along with a review of the supporting literature. Some of the major concerns expressed by children have been illustrated. In summary, the following are the essential points to keep in mind when planning pediatric patient care: Honesty. There is no substitute for the trust developed between an honest physician and the patient. Awareness of developmental concerns. The timing, wording, and presentation of preparation materials must be based on an accurate assessment of the child's cognitive and emotional readiness. Involvement of the patient and parent in decision making, treatments, and procedures whenever possible. Patients and families who feel in control are much more trusting and receptive to the physician's plan. Follow-up. Make certain the patient and family are aware of your continued concern for their well-being. In addition, ask what they feel helped them and their child the most, and what could have been done to be more helpful. This helps continued refinement of a program designed to meet client needs.

Adolescent↗

PubMed1987

Trace mineral supplementation of burn patients: a national survey.

Much research effort has been devoted to determination of caloric and protein requirements in burn patients. Although it is generally accepted that trace mineral requirements increase concomitantly with caloric and protein needs, little research has been conducted to document that assumption. Our survey was undertaken to assess current practice and identify research needs. One hundred ninety-six survey questionnaires were sent to burn units in North America. Forty percent (78) were returned. Ninety percent of respondents prescribe or recommend trace mineral supplements in their facilities. "Higher risk" was the single criterion most often mentioned as a basis for supplementation (54 [77%] of 70 respondents), with 49 of them indicating that they provide trace mineral supplements to patients receiving total parenteral nutrition support. Fifty-six respondents provided detailed information concerning trace mineral supplementation. Of that group, 88% prescribe zinc supplements, 75% prescribe iron supplements, and 26% prescribe chromium supplements. Thirteen percent supplement selenium. Less than 2% supplement molybdenum or vanadium and do so only when administering total parenteral nutrition. Many respondents expressed concern about the lack of guidelines for trace mineral supplementation in the burn patient, leading to the conclusion that further research in that area would benefit burn-injured patients and the health care providers who care for them.

Burns↗

PubMed2002

Assessing risk: professional perspectives on work involving mental health and child care services.

The assessment of risk is central to work with families where parental mental health needs and child care concerns coexist. This article reports on the findings of three interprofessional focus groups which examined professionals' experiences of working with such families. Specialisation and differing thresholds and codes were identified as factors which contributed to difficulties for practitioners and families and scepticism was expressed concerning the feasibility of a key worker system for this group. The issue of psychiatric diagnosis evoked ambivalent responses and was both valued as offering direction for planning interventions and seen as a means of labelling and excluding individuals from services. The focus group participants were aware that assessing risk placed families under considerable pressure, but practitioners themselves also appeared to experience an emphasis on risk as restrictive.

Adult↗

PubMed2006

Quality indicators for cardiac care: national standards in a community context.

OBJECTIVE: Public reporting of health data is well established in the United States and in the United Kingdom, and is assumed to promote better health care through informed choice by consumers. To be successful, reporting systems must have the support of physicians, but their opinions have been mixed. The purpose of this study was to explore with practising physicians the perceived usefulness of, and barriers to use of, quality indicators in the care of acute myocardial infarction and congestive heart failure, and the contexts in which these issues arise. METHODS: Six focus groups were conducted in small-, medium- and large-sized communities in two provinces in Canada. Subjects were family physicians, emergency physicians, internists and cardiologists. Data were analysed inductively. RESULTS: Our participants were generally supportive of the quality indicators, with concerns expressed regarding interpretation of data from measures created by "experts" but applied in the context of community hospitals and community-based practice. Content analysis disclosed that a majority of the indicators was acceptable; few were outright unacceptable. Inductive analysis revealed two contextual concerns: issues arising from the structure and organization of the health care system, such as equitable access to health care resources and discontinuity or fragmentation of the system, and patient-related issues, such as compliance with medications post-discharge and costs of medications. CONCLUSIONS: There is general support for this set of quality indicators, with the caveat that data should be carefully interpreted in the context of each community in which they are applied.

Attitude of Health Personnel↗

PubMedDate not supplied

Pediatrician practices regarding referral to early intervention services: is an established diagnosis important?

OBJECTIVE: Early intervention (EI) programs provide services to children with developmental conditions, regardless of whether such children have an underlying medical diagnosis. We aim to (1) Determine the proportion of general pediatricians who believe an established diagnosis is important when considering EI referral; and (2) Determine whether this perception is associated with lower reported likelihood of referral. METHODS: Mailed survey to random sample of pediatricians. We used multivariable logistic regression to study the association between the perception that a medical diagnosis is important when referring to EI, and the reported likelihood of EI referral for children with common developmental conditions. RESULTS: Response rate was 55% (894 of 1617). A total of 64% of respondents considered an established diagnosis important for EI referral. Likelihood of referral for delayed speech was lower among those who considered a diagnosis important than among those who did not (77% vs 87%; P = .02). Similar patterns held for global delay (91% vs 97%; P = .02), loss of developmental milestones (80% vs 88%; P = .03), and parental concern for inappropriate development (45% vs 60%; P = .002). In multivariable models, perception of the importance of an established diagnosis was associated with lower likelihood of referral for children with delayed speech (adjusted odds ratio [aOR] 0.48; 95% confidence interval [CI] 0.26-0.87) and for parental concern for inappropriate development (aOR 0.46; 95% CI 0.30-0.72). CONCLUSIONS: A majority of general pediatricians believe that an established diagnosis is important when considering EI referral. This perception is associated with decreased reported referral for children with speech delay and those whose parents express concern for inappropriate development.

Attitude of Health Personnel↗

PubMed1990

Stability of patient preferences regarding life-sustaining treatments.

Physicians often express concern about the reliability of critically ill patients' preferences regarding life-sustaining treatments. We interviewed 30 Veterans Administration intensive care unit patients to determine their preferences for resuscitation, resuscitation requiring mechanical ventilation, artificial hydration and nutrition, and hospitalization for treatment of pneumonia. Patients expressed their preferences considering their current health and then two hypothetical scenarios, stroke and dementia. Follow-up interviews occurred one month later to assess preference stability. We found a diversity of opinions about life-sustaining treatments. Despite significant changes in health status and mood (p less than 0.05), treatment preferences were stable over time (kappa = .35-.70). Our results suggest that life-sustaining treatment preferences solicited during a serious illness are reliable and may be used in decision-making when a patient becomes unable to communicate or is mentally incapacitated.

Aged↗

PubMed2002

Influenza vaccination: is it appropriate in chronic fatigue syndrome?

Chronic fatigue syndrome (CFS) is a recognized clinical illness of unknown cause and pathophysiologic mechanisms. Immunizing patients against influenza would seem to be a prudent strategy since infection has been associated with symptom exacerbation. However, patients with CFS have demonstrated variable abnormalities in the immune system, the clinical significance of which is unclear. Anecdotal information has suggested that, due to the etiologic uncertainty surrounding CFS, many patients reject immunization, fearful of untoward effects. This article attempts to clarify the situation by reviewing immunologic findings in CFS and influenza vaccines in current use. Results from a recent survey of perceptions of patients with CFS regarding immunization revealed that 31% felt immunization was neither safe nor beneficial. This opinion was universal in those patients who had never received influenza vaccine. Among patients who had received vaccine and experienced an adverse effect, 26% felt the vaccine was safe and 28% felt it was beneficial. Among those who had received vaccine without an adverse effect, 45% believed the vaccine was safe, and 55% felt it was effective. CFS patients as a group expressed concern that influenza vaccine would alter an already dysfunctional immune system, or worsen CFS symptoms. Significantly more patients with CFS who had never received influenza vaccine voiced this opinion than did patients who had received immunization for influenza in the past. Contrary to the opinions expressed by the sample, clinical trials in CFS have yet to find that any type of immunization has produced a deleterious effect on symptoms or functioning. Moreover, patients with CFS in a randomized, placebo-controlled, double-blind trial of influenza immunization produced an antibody titer in the protective range to inactivated trivalent influenza vaccine, although the geometric mean titer was slightly blunted compared with healthy vaccinees. Although patients with CFS in placebo and active groups reported four times the number of post-injection adverse effects of healthy vaccinees, data re-analysis revealed that this finding was related to the overlap of common, post-influenza immunization symptoms and CFS constitutional symptoms. CFS is a poorly understood illness and some patients may believe in causal theories that lead to the rejection of disease prevention strategies such as immunization. However, influenza immunization appears to provide protective antibody levels without worsening CFS symptoms or causing excessive adverse effects. Efforts to motivate patients with CFS to obtain annual influenza immunization should take into account illness perceptions and concentrate on education based on placebo-controlled trials.

Attitude to Health↗

PubMed1999

Feast or famine? Supplemental food programs and their impacts on two American Indian communities in California.

This article examines the use of supplemental food programs by two Native American populations and assesses some of the health and cultural impacts of these programs. A cross-sectional survey of 80 American Indian families, 40 families residing on the Round Valley Indian Reservation and 40 in Sacramento, California was conducted to determine access, use and appropriateness of supplemental feeding programs. Respondents at both the rural and urban geographic location showed considerable familiarity with available supplemental feeding programs. USDA Food Commodities were utilized most at Round Valley, raising the concern that provided staples which were highly processed and contained significant amounts of sodium, sucrose, and fat, could contribute to the problems of obesity and diabetes. Native Americans in Sacramento used food banks and food closets as their primary source of supplemental foods, and some expressed concern that the foods provided were highly sweetened and high in fat. While some nutrition advising was available at both geographical localities, access was inadequate. The study found that the foods provided by the supplemental food programs varied considerably in their nutritional quality and healthier foods such as fresh fruits, vegetables, and meats were either completely lacking or in short supply. In addition, culturally sensitive nutritional counseling and the development of education modules to instruct program recipients in the preparation of healthy meals and how to manage obesity and diabetes were needed and requested within the California Native American communities surveyed.

Adult↗

PubMed2003

Chronic pain management--can we do better? An interview-based survey in primary care.

BACKGROUND: Persisting pain is demoralising and debilitating for patients and their carers. Most patients with chronic pain do not need the services of a specialised pain clinic and are appropriately managed by their general practitioner (GP). METHOD: Interviewers approached 569 GPs to assess their satisfaction with the management of patients with chronic non-malignant (i.e. non-cancer related) pain (CNMP). The survey was carried out from November 2001 to January 2002 in general practices in the UK. GPs were randomly selected as representative of the basic population who treat CNMP. The survey was conducted in a face-to-face interview in the GP surgery using a questionnaire consisting of 35 open questions covering practice information, treatment of CNMP, pain management and multidisciplinary support. RESULTS: 504 (88.6%) of GPs completed the structured questionnaire. 81% of GPs believed that a significant number of patients received suboptimal management. Optimal control of symptoms was estimated to occur in less than half of patients. The main barriers to achieving good pain control were identified as side-effects of therapies (74%) and patient compliance (58%). 60% of respondents expressed concerns regarding efficacy of available therapies. Although 91% of GPs considered specialised pain services as beneficial, only 14% of patients were referred to hospital for symptom management. 96% of GPs felt that the management of chronic pain could be improved in their locality and 81% expressed an interest in relevant training. CONCLUSION: Most GPs believe that the management of chronic pain can be improved. Further education of all healthcare professionals who manage patients in pain is needed to bring about such a change.

Chronic Disease↗

PubMed1995

Prescribers' and users' perspective of CFCs: a market research survey.

Focus groups were conducted with physicians, pharmacists and patients prior to semi-structured interviews with physicians and patients. The survey was conducted in Spain, Germany and the UK. There were high levels of awareness of environmental issues, with ozone layer damage and global warming being of particular concern. Most respondents were aware of chlorofluorocarbon (CFC) use in aerosols and in refrigerators. However, their presence in asthma metered dose inhalers (MDIs) was much less widely known. German physicians had the highest awareness (78%) while only 1 in 10 of UK patients was aware. Patients expressed concern on learning that they inhale CFCs. Reaction to the concept of a non-CFC propellant was universally favourable, though sometimes qualified with the need for adequate safety and efficacy data. Patients expected to be informed of the change by doctors, pharmacists or patient information leaflets. Physicians expected to receive information as soon as possible but did not want patients informed until launch. Manufacturers and representatives would be the primary information sources for physicians. Pack changes should be minimised. Communicating the change to non-CFC propellants to physicians, pharmacists and patients is all important.

Chlorofluorocarbons↗

PubMedDate not supplied

Does Dixon's Integrative Environmental Health Model inform an understanding of rural parents' perceptions of local environmental health risks?

A qualitative study of parents' perceptions of local environmental health risks was conducted to assess the fit between concepts from Dixon's Integrative Environmental Health Model (DIEH model) and field-generated data. This research was part of a prospective study addressing environmental exposures of rural low-income children. Home visit data from 11 parents were analyzed (1) thematically and (2) according to DIEH concepts. These complementary analyses allowed the researchers to examine perceptions that were congruent with or diverged from the DIEH model. Findings revealed that participants were concerned about children's exposure to pathogenic molds and cigarette smoke and felt uninformed about risks and prevention strategies. Barriers to preventive actions included families' lack of time and a disinterest in brochures. Participants reported being "stuck" in substandard housing by poverty and family demands. They expressed concern about risks, but were unsure "what to worry about." Results provided the researchers with confidence that the DIEH model aligned with participants' cognitive constructions of risk. As a result, the DIEH model was incorporated into the conceptualization for the clinical trial phase of the study. This type of check between a theoretical approach and field data can be a helpful intermediate step for researchers involved in multiyear studies.

Adult↗